Dr. Richard J. Hempel, MD

Dr. Richard J. Hempel, MD A true partner in health who you can reach 24/7 and see same- or next-day. He sees fewer patients, which means more time for each one.

Dr. Hempel, Board Certified Family Medicine physician, offers a different approach to primary care. Patients appreciate same/next-day appointments that start on time and aren't rushed; plus they can usually reach his 24/7. His practice also offers other services, including comprehensive, advanced health screenings and diagnostic tests, that go far beyond those found in concierge medicine practices. Dr. Hempel develops a personalized wellness plan based on the results of the wellness program. His MDVIP-affiliated practice is open to new patients.

I almost never post on Facebook, but I thought Robert Reese Hempel mandated an exception. Maybe the cutest baby ever.
02/23/2022

I almost never post on Facebook, but I thought Robert Reese Hempel mandated an exception. Maybe the cutest baby ever.

01/05/2022

I know it has been a while since I have posted anything on my page. It seems that so much of the current focus in medicine has been on COVID19 and there has been so much information available and so many varied sources, that I was not sure what to add. As we pass two years of dealing with this virus and are in the midst of another wave of coronavirus that is the biggest yet, I have decided to come out of hiding and provide some optimism about where we are now with this virus.

• Vaccines worked incredibly well. Over 90% of the people dying in the hospital from COVID-19 are unvaccinated. This is true, in spite of a majority of the population being vaccinated. People who get vaccinated just don’t get nearly as sick. If you do get vaccinated and are reasonably healthy the chances of dying of COVID-19 are really negligible. The vaccines are also amazingly safe and have comparable safety to the typical vaccine we have given for other infectious diseases for my whole career.

• The current omicron variant is less virulent and more infectious than delta or the previous variants. It appears to have less injury to and affinity for lung tissue. Many people are still dying of the Omicron variant, but that is because so many people are being infected and the pool of unvaccinated people is still relatively high. Even though the proportion of people getting very ill is lower, the number of infections is also much higher. Also there are many breakthrough infections especially in the partially vaccinated. Remember that the current vaccine was designed for the original SARS CoV-2 and the newer variants are gradually evolving away from that strain. Fortunately, if you were vaccinated and particularly if you are boosted, your illness is almost certainly going to be mild. A boosted individual appears to have about 50 to 60% total protection against all variants at this point. On the other hand, the unvaccinated run the risk of severe illness and death.

• Another optimistic finding is that the available rapid antigen tests detect omicron well so they can be used to monitor for infectivity. A negative antigen test 5 days after developing COVID19 means you are very unlikely to be infectious as long as you are otherwise recovering.

• We now have an antiviral drug, paxlovid, which appears safe and extremely effective at reducing hospitalizations and death if given within 5 days of the initial infection. The majority of people that will need this drug are unvaccinated folks at high risk. It is going to be a while until it is readily available so please get vaccinated so you won’t need it.

• In the last month, all of my patients who have been infected and have been vaccinated have been very mildly ill with a short duration of symptoms.

• I’ve had two previous patients die in the last few months both of whom were unvaccinated and who was otherwise extremely healthy. An avoidable tragedy.

• The bottom line is that we are really making progress against this virus when it comes to death and hospitalizations for the vast majority of people who are willing to get vaccinated.

• In conclusion, get vaccinated now and boosted as soon as the option is available. Notify your provider if you get sick with coronavirus and if you are not vaccinated let them know immediately since you may be a candidate for paxlovid or monoclonal antibodies that can dramatically improve your chances of not getting severely ill.

• I know it has been a very long road, but I can finally see the light at the end of the tunnel and I’m starting to become very hopeful we can soon get back to practicing normal preventive medicine instead of focusing every day on COVID-19.

We have a vaccine clinic this Friday January 7th at my office. If you need the initial vaccine or a booster feel free to call 859-236-3957 and schedule an appointment for the vaccine.

05/18/2021

Is it Time to Get the Vaccine?

I have not been posting for a while. I guess the pandemic finally wore me down and even though it was still the daily topic it seemed like we were moving in the right direction and I decided to stay pretty quiet. The vaccines came out and were readily available even though I didn’t have a supply for my office. So now I have the Moderna vaccine in my office and I am ready to give it to anyone who might not have been vaccinated who is over 18 years of age. What I have found is that the group wanting to get vaccinated at this point is smaller than I had hoped.

I know for most of you this is “speaking to the choir”. You have already had the vaccine and many of went to extraordinary efforts to get vaccinated. Good for you.

This message is primarily for those who have not been vaccinated. I know, for some, there are political and religious controversies related to the vaccine. In this instance, I would ask you to put aside those concerns and focus on the risks versus the benefits of this vaccine. I have had over 50 patients who have been sick with COVID19 and about 75% of my patients have been vaccinated. The clear winner is the vaccine. I have had no one die from COVID19 so far, but the folks that have had the infection for the most part had much worse effects from the illness than any patient who was vaccinated. In the hospital I have seen several people die of COVID19. None with the vaccine.

The number of people vaccinated is now in the multimillions and the side effects have been miraculously minimal. Now adults, pregnant women and children 12 years and older have all proven that they can be safely vaccinated. The efficacy of the vaccine in real life experience has been even more impressive than we expected and the Moderna vaccine has worked beautifully.

If you don’t get the vaccine I understand that as a personal decision, but I stand ready if you do change your mind and will be available to guide you through any side effects. If you do get the vaccine, you will almost certainly not die or be hospitalized from COVID19. Also, you may very well save someone else’s life that would have gotten infected if you had not been vaccinated and ended up spreading the virus. Finally, and not insignificantly, getting the vaccine will speed up the process of getting back to normalcy.

Think about it.

01/31/2021

What’s going on with COVID19 vaccines?

As we try to increase the number of vaccines distributed in the United States, the number of options and concerns continues to make the situation more confusing. We have two vaccines currently approved in the US (both mRNA vaccines) that originally showed an approximate 95% overall efficacy. Now we have three other candidate vaccines very close to approval; a Johnson and Johnson single shot option, Novavax protein vaccine and the Oxford AstraZeneca adenovirus vector option that is already approved in the United Kingdom. Multiple others are still in earlier phases of development.

All of these vaccines reach the threshold of 50% efficacy required by the FDA for approval in their phase 3 trials, but their efficacy in general is less than that of the Moderna and Pfizer-BioNtech vaccines.
Confusing the picture further is the virus itself which is rapidly mutating. Variants from South Africa (B.1.351), Great Britain (B.1.1.7) and Brazil (B.1.1.28.1) appear to increase infectivity and possibly mortality. The vaccines appear to have some, albeit reduced, efficacy to these new mutants. The South African variant has been shown to reinfect a person previously infected with the original strain of SARS-CoV-2. Moderna says that it will test whether an extra booster dose of its two-dose COVID-19 vaccine will provide additional protection against emerging strains of SARS-COV-2 and they are testing a new vaccine specific for the South African variant.

The important thing to understand is that the more worldwide infections that occur, the more viral replication takes place which leads to more mutations which in turn leads to more contagious variants that will eventually select for vaccine resistant strains. That is natural selection at work. The way to stop this occurrence is by stopping viral replication. Less viral replication leads to fewer mutations. That means getting more people vaccinated, keeping away from infected people, wearing a mask(or two) to minimize spread and avoiding exposure to poorly ventilated environments or situations where you contact a surface that was very recently contaminated. Basically using all the mitigation efforts public health officials have been advocating for some time. If we work together I believe we can shut down the pandemic by the early fall.

So my current advice is get vaccinated as soon as you can with whichever vaccine is available. I suspect the Johnson and Johnson vaccine will have greater efficacy when data is available on a two dose option; information that will be coming soon. In the mean time any vaccine is better than none.

I am working in preparation for having the vaccine available in my office. Since I don’t have it now, if you have the opportunity to get vaccinated somewhere else please do so.

Today I took the COVID19 vaccine!! I didn’t really think to dress for the occasion.
12/23/2020

Today I took the COVID19 vaccine!! I didn’t really think to dress for the occasion.

12/23/2020

Should I Take the Vaccine?

The short answer is “yes”. I have been skeptical about the vaccine because the time line from of development has been so short and politics has tainted some of the discussions about the vaccine, but the more I have learned about it the more reassured I am that no safety or efficacy short cuts have been taken that would make me not want to get immunized now.

My reasoning is pretty simple. Although I am not a vaccine expert, the information used to make decisions about the vaccine has been remarkably transparent and unequivocal. I have relied on reading this information and listening to the advice of the vaccine experts. I evaluate new medications, medical devices and vaccinations for my patients all the time and have developed a fairly good skill at skeptically evaluating new medical advances. Safety is always a concern, but the side effects of the new vaccines have been in general minimal. Now at least 3 people in the US have had severe allergic reactions, but well over 600,000 people in the US have received the vaccine which reflects a very tiny portion with this reaction. Also, these people were effectively treated and are doing fine now. A few cases of Bell’s palsy may or may not be related to the vaccine, but there have been no frightening surprises from the vaccines thus far concerning safety. Efficacy has been nothing short of astounding. For the Pfizer and Moderna vaccines, efficacy in preventing clinical infection has been about 95%. So are there still some unknowns about the vaccine? Of course, but those unknowns must be weighed against what we know about the consequences of the natural infection.

SARS-CoV-2 which causes COVID19 is not an infection to be taken lightly. Over 310,000 people in the US have died while infected with this virus and millions more are still recovering from the infection. The long term consequences of the infection may include persistent fatigue, shortness of breath, taste and smell disturbances and impaired cognition. Although most individuals will have relatively mild disease, even that type illness can mean 1-2 weeks of feeling poorly. We of course don’t know the long term consequences of the vaccine, but they appear to pale in comparison to all the possible adverse consequences of the natural infection. Other concerns such as predisposition to dementia or cardiomyopathies or chronic lung disease are not proven, but legitimate concerns for those that have been infected.

So today I got the vaccine through Ephraim McDowell Hospital. I got the Moderna vaccine which has great data and a well done phase 3 trial showing safety and efficacy. I will be looking hard to acquire the vaccine for my patients and staff so that they also can get immunized very soon. I will contact everyone as I get more information.

If I get a sore arm, fatigue, headache and chills or other similar side effects, I will still feel blessed that I am initiating the protection needed to avoid COVID19 which has been by far the most destructive infection and society changing illness in my lifetime.

ACIP Evidence to Recommendations for Use of Moderna COVID-19 Vaccine under an Emergency Use Authorization

ACIP Evidence to Recommendations for Use of Pfizer-BioNTech COVID-19 Vaccine under an Emergency Use Authorization

11/16/2020

Good News on COVID19!!

11/16/2020

Finally a COVID Game Changer!
Most of the news concerning COVID19 has been abysmal lately. The number of cases has skyrocketed and our country and local healthcare resources are being severely challenged. The tidbits of good news like the value of steroids and anticoagulants to reduce severe COVID disease are more than offset by the staggering increase in cases. Over 200,000 additional people in the US are likely to die through the winter due to the severity of the current outbreak.
Now comes the good news. Actually amazing and almost miraculous news. Two companies, Pfizer and Moderna have presented preliminary data that suggests their new mRNA vaccine is over 90% effective in preventing infection with very acceptable side effects. This efficacy rate is much greater than most anticipated and has the possibility of stopping the infection in its tracks if we can effectively distribute the vaccine and gain enough public confidence to have the vaccine accepted by most. It also appears that the Moderna vaccine may not have as rigorous storage requirements making it easier to manage in clinic settings. Regardless, if it is safe and you take it, it appears you are very likely to be protected. Thus, even if the uptake is slow for the whole of our population, any one individual who gets the vaccine will be protected. I plan to read carefully the scientific data as it is presented when both of these pharmaceutical companies ask for emergency use authorization (EUA) for their vaccines. If the ongoing data looks as good as the preliminary reports, the risk/ benefit for the vaccine is to get it as soon as possible.
I have been disturbed that COVID19 infections are multisystem and appear to have many long term effects in some that we have not even yet uncovered I do not want anyone to get this infection, even if they are likely to survive.
Now that we have hope of a vaccine very soon, it is especially important to do everything possible to avoid infection. Avoid large indoor group activities, social distance, wear a mask and wash your hands frequently. Let’s all try our hardest for the next few months. I believe the reward of enduring a few more months of COVID fatigue will be worth it in the long run.
Stay safe. I am trying to move many of my patient visits to virtual, but I remain available by phone or in person for health care issues as they arise. Stay safe and be hopeful. Help is on the way.
PFIZER AND BIONTECH ANNOUNCE VACCINE CANDIDATE AGAINST COVID-19 ACHIEVED SUCCESS IN FIRST INTERIM ANALYSIS FROM PHASE 3 STUDY
Monday, November 09, 2020 - 06:45am
Moderna’s COVID-19 Vaccine Candidate Meets its Primary Efficacy Endpoint in the First Interim Analysis of the Phase 3 COVE Study
November 16, 2020 at 6:56 AM EST

09/02/2020

COVID19 Update: How is the novel coronavirus transmitted?

Our understanding of the transmission of SARS-CoV-2 has been evolving over the last 9 months. We have thought in the past that the main mode of spread of the virus is by direct droplet transmission—an infected and symptomatic person coughs or sneezes on someone and they become infected. We also know that fomites (objects that can transiently harbor the virus until someone contacts the surface and acquires the virus) are a source of infection. Many people became hyper vigilant to prevent contact with any surface that might have been contaminated and some even went so far as to leave Amazon boxes outside for a day or two before bringing them inside and wiping them thoroughly in an attempt at decontamination. Eventually we realized asymptomatic or minimally symptomatic people could transmit the virus and that masks could significantly reduce transmission and needed to be worn by all people in high risk situations since they may be infected and not even know it.

Now a new study from China published in JAMA Internal Medicine suggests that airborne transmission is much more likely than we originally thought. Most other common coronavirus infections and other respiratory viral infections are mainly transmitted by droplets and fairly direct exposure. Roughly 125 Buddhists in China traveled on two heated buses to a 2.5-hour outdoor worship event in January (before public awareness of COVID-19 in that area); they were on the buses for a total of 100 minutes. The index patient began to experience COVID-19 symptoms that evening, upon return. Over one third of those on the same bus as the index patient were diagnosed with COVID-19. None on the other bus were infected. Passengers on the bus with the index patient became infected regardless of their proximity to the patient. The researchers conclude, "The investigations suggest that, in closed environments with air recirculation, SARS-CoV-2 is a highly transmissible pathogen."

This information confirms that aerosolized droplets can spread the infection even without close contact. We know that measles and tuberculosis are transmitted by aerosols. The more positive aspect to transmission is that it appears that each individual must reach a level of exposure that transmits the infection. Measles requires minimal exposure while TB requires a much longer exposure. SARS-CoV-2 is somewhere in between. Minimal time exposure (

08/09/2020

COVID 19 How can I prevent getting Infected with the Novel Coronavirus?

Much has been written about how to prevent infection with SARS-CoV-2, the causal agent of COVID19. I get asked on an almost daily basis things one might do to prevent infection.

At the risk of being obvious, the most important thing that any of us can do is stay away from infected people. At this writing, the rate of positive tests in Kentucky is > 6% and the number of cases is increasing at a significant rate. Areas that we thought were safe have shown the emergence of increased cases. So if you have the opportunity to stay at home and away from others (especially if you are > 65, obese, have diabetes, COPD or other lung disease, hypertension or are immunocompromised) please do it.

Unfortunately, many of us have to be exposed to others in the public and can’t always prevent contact with people around us. Masks have turned out to be remarkably more effective than originally thought so wear a mask when in public around others and keep a social distance if at all possible(>6 feet). Avoid poorly ventilated areas and staying in the proximity of others with unknown COVID status for more than 10 minutes. Wash your hands frequently and don’t contact surfaces that are likely to have been recently touched by other individuals unless you decontaminate your hands before any contact with other parts of your body-especially your face.

What about medications or supplements to prevent infection? It would be great if we could find a medication or supplement that would prevent COVID19. Unfortunately the science on this issue has gotten confused with politics and we are mired in contentious unscientific discussions about medications. Perhaps the most confusing is hydroxychloroquine (HDQ). There have been many anecdotal and uncontrolled reports of great benefit for this medication. Some have latched on to these preliminary reports and have hoped that this medication would be a panacea. There are still multiple trials ongoing using hydroxychloroquine, but the initial reports from randomized controlled trials, which are the gold standard for proof in medicine, have thus far not been favorable. In a double-blind trial, 821 individuals were randomly assigned to hydroxychloroquine or placebo folate tablets within four days of a household or occupational exposure to SARS-CoV-2, which was defined as contact within six feet for more than 10 minutes without an eye shield; most were also not wearing a medical mask. HDQ did not reduce the rate of the combined outcome of polymerase chain reaction (PCR)-confirmed COVID-19 or consistent symptoms within 14 days (11.8 versus 14.3 percent with placebo, difference -2.4 percentage points, 95% CI -7.0 to 2.2); there were also no differences in the separate rates of PCR-confirmed or presumed cases. Side effects were reported in 40.1 percent of hydroxychloroquine-treated versus 16.8 percent of placebo-treated subjects. Loss to follow-up in about 11 percent of cases, a greater rate of treatment discontinuation in the HDQ group, and use of self-reported symptoms as a proxy for incident COVID-19, reduce confidence in the findings; nevertheless, the study did not demonstrate a role for hydroxychloroquine for prevention of COVID-19.

The other RCTs involved treatment at various times during the illness and with mild, moderate and severe disease. None of these studies were favorable for hydroxychloroquine so the best current science is to not take HDQ to prevent or treat COVID19. Does this mean that a future RCT is unlikely to show a benefit for HDQ? I don’t think so. I wouldn’t be surprised if a benefit existed in a specific subset of people. We just don’t know the group that would benefit and my suggestion would be to wait for the science to support a use based on proper trials and not anecdote.

Other considerations are zinc, azithromycin, multivitamins, chiropractic and almost any “immune booster”. Maybe one or more of these interventions will prove helpful, but my suggestion would be to listen to the medical community. I believe medical scientists want desperately to help all of us get through this pandemic. Because of the extremely high stakes and lack of definitive answers, the opportunity for misinformation both well intentioned and nefarious is very great. So when someone touts a treatment or preventive for COVID19 please talk to a healthcare provider you trust that can help make sense of this very confusing topic.

In summary, distance yourselves from others, wear a mask when in public, wash your hands and for now don’t depend on a medication to protect you.

I will be the first to admit that I do not have all the answers about COVID19 (and most other diseases), but I do have experience interpreting medical information and trying to apply an evidenced based approach to interpreting the data. I have enjoyed the evolution of our understanding of this unique new virus from an educational standpoint; I am just so sorry that the consequences of infection can be so very dire. My office is open during these trying times and we remain ready to help.

A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19.
AU
Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, Skipper CP, Nascene AA, Nicol MR, Abassi M, Engen NW, Cheng MP, LaBar D, Lother SA, MacKenzie LJ, Drobot G, Marten N, Zarychanski R, Kelly LE, Schwartz IS, McDonald EG, Rajasingham R, Lee TC, Hullsiek KH
N Engl J Med. 2020

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